Endovascular treatment of spontaneous isolated abdominal aortic dissection

Abstract

Isolated abdominal aortic dissection is a rare clinical disease representing only 1.3% of all dissections. There are a few case series reported in the literature. The causes of this pathology can be spontaneous, iatrogenic, or traumatic. Most patients are asymptomatic and symptoms are usually abdominal or back pain, while claudication and lower limb ischemia are rare. Surgical and endovascular treatment are two valid options with acceptable results. We herein describe nine cases of symptomatic spontaneous isolated abdominal aortic dissection, out of which four successfully were treated with an endovascular approach between July 2003 and July 2013. All patients were men, smokers, symptomatic (either abdominal or back pain or lower limb ischemia), with a history of high blood pressure, with a medical history negative for concomitant aneurysmatic dilatation or previous endovascular intervention. Diagnosis of isolated abdominal aortic dissection were established by contrast-enhanced computed tomography angiography (CTA) of the thoracic and abdominal aorta. All nine patients initially underwent medical treatment. In four symptomatic cases, non-responsive to medical therapy, bare-metal stents or stent grafts were successfully positioned. All patients completed a CTA follow-up of at least 12 months, during which they remained symptom-free. Endovascular management of this condition is associated with a high rate of technical success and a low mortality; therefore, it can be considered the treatment of choice when it is feasible.

Keywords: Abdominal aorta; dissection; endovascular technique; stent grafts; stents.

Fig. 1.

Preoperative CTA showing “double-barreled” appearance of the abdominal aorta (a). Completion angiogram after bifurcated stent graft deployment (b). CTA 8 years after treatment showing good placement of the stent graft without any recurrence (c). CT scan axial image showing abdominal aortic dissection involving to iliac arteries (d). Intraoperative digital subtraction angiography demonstrating good placement of aortic and kissing bare metal stents (e). Postoperative CT scan showing good patency of aortic and iliac stents and complete disappearance of false lumen (f).